Provider Demographics
NPI:1508180753
Name:PROGRESSIVE DENTISTRY OF CT, P.C.
Entity Type:Organization
Organization Name:PROGRESSIVE DENTISTRY OF CT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FREDRIC
Authorized Official - Middle Name:L
Authorized Official - Last Name:ROSEN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:203-776-8556
Mailing Address - Street 1:315 WHITNEY AVE
Mailing Address - Street 2:SUITE 6
Mailing Address - City:NEW HAVEN
Mailing Address - State:CT
Mailing Address - Zip Code:06511-3715
Mailing Address - Country:US
Mailing Address - Phone:203-776-8556
Mailing Address - Fax:203-776-1475
Practice Address - Street 1:315 WHITNEY AVE
Practice Address - Street 2:SUITE 6
Practice Address - City:NEW HAVEN
Practice Address - State:CT
Practice Address - Zip Code:06511-3715
Practice Address - Country:US
Practice Address - Phone:203-776-8556
Practice Address - Fax:203-776-1475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT43971223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Multi-Specialty